Inside Health

OBAMA LAYS OUT HIS HEALTH PLAN

By SHERYL GAY STOLBERG and DAVID M. HERSZENHORN; Robert Pear contributed reporting.

Published: February 23, 2010

President Obama on Monday issued his own blueprint for a health care overhaul, challenged Republicans to come forward with their ideas and laid the groundwork for an aggressive parliamentary maneuver to pass the legislation using only Democratic votes if this week brings no progress toward a bipartisan solution.

In laying out for the first time the details of what he wants in the legislation, Mr. Obama set in motion a new round of maneuvering intended to bring a bitterly divisive yearlong clash to a conclusion. With the two parties scheduled to meet Thursday for a televised session on the health care overhaul, Mr. Obama appeared intent on forcing the Republicans into a choice: either put a specific alternative on the table, giving Democrats a chance to draw pointed contrasts between the parties' approaches, or be cast as obstructionist and not serious about addressing an issue of great concern to voters.

The initial Republican response suggested the two parties are more likely headed toward a showdown than toward a deal. Representative John A. Boehner of Ohio, the House Republican leader, said Mr. Obama had ''crippled the credibility'' of Thursday's meeting by proposing ''the same massive government takeover of health care'' that Americans had already rejected.

The bill, which the White House estimates would cost $950 billion over a decade, aims to fulfill Mr. Obama's goals of expanding coverage to millions of people who are uninsured, while taking steps to control soaring health care costs. It sticks largely to the version passed by the Senate in December, but offers some concessions to House leaders who have demanded more help for middle-class people.

Mr. Obama's measure would, for example, eliminate a highly criticized special deal to help Nebraska pay for a proposed Medicaid expansion, and would instead provide more help for all states to pay for their new Medicaid enrollees. It would delay enactment of a controversial tax on high-cost employer-sponsored insurance plans and, in a nod to the concerns of older Americans, do away with the unpopular ''doughnut hole'' in the Medicare prescription drug program.

But more than a specific policy prescription, the measure is a gamble by a president trying to keep his top legislative priority alive. The White House signaled more clearly than it had until now that barring a bipartisan breakthrough, Democrats would try a legislative maneuver known as reconciliation to pass the bill through the Senate on a simple majority vote, avoiding the 60-vote supermajority needed to avert a Republican filibuster.

By using the existing Senate bill as the basis for his proposal, Mr. Obama made it easier for Democrats to try to execute that parliamentary tactic, though the maneuver would bring vehement Republican opposition and remains subject to all kinds of procedural challenges.

''The president expects and believes the American people deserve an up or down vote on health reform,'' Dan Pfeiffer, Mr. Obama's communications director, said in a morning conference call with reporters. ''And our proposal is designed to give us maximum flexibility to ensure that, if the opposition decides to take the extraordinary step of filibustering health care.''

But leading Republicans -- including Senator Olympia J. Snowe of Maine, whose vote Mr. Obama courted assiduously, and unsuccessfully, last year -- called on the president to renounce reconciliation. In a brief interview on Capitol Hill on Monday, Ms. Snowe said using the procedure would be ''a huge mistake.''

By unveiling its own proposal and posting it on the White House Web site, whitehouse.gov, the administration was trying to combat the relentless attacks on Mr. Obama's approach while also challenging Republicans to come forward with their own comprehensive solution to the problems in the health care system.

Republicans say they do not share the goal of a comprehensive bill, but White House officials say they can shift the debate to their terms if it is framed as a choice between competing ideas rather than a referendum on the Democrats' legislation.

The White House even offered Monday to post the Republicans' plan on its Web site. ''We had a clear majority in both the House and the Senate that voted for this bill,'' said Representative Henry A. Waxman, the California Democrat and one of the authors of the House version. ''If Republicans do dig themselves in against it, Democrats ought to realize that they're going to be attacked for having voted for the bill, so we might as well get the job done.''

Representative Nancy Pelosi, the House speaker, did not immediately embrace the plan, but instead scheduled a caucus meeting for Monday evening.

A combination of vacant seats and unresolved disputes over issues like restrictions on abortion financing under the health care legislation have left the White House short of the votes it needs in the House, meaning Mr. Obama has his work cut out for him in assembling even simple majorities in both chambers.

The White House projects that Mr. Obama's bill would extend coverage to 31 million people who are currently uninsured, at a cost over 10 years of $950 billion -- more than the $872 billion the Senate would have spent, but less than the $1.05 trillion for the version passed by the House. The administration estimates that its plan would reduce the federal deficit by $100 billion over the next 10 years -- and even more over the second decade -- by cutting spending and reining in waste and fraud.

But the measure has not been evaluated by the nonpartisan Congressional Budget Office, whose analyses are widely considered the final word on Capitol Hill. The office's director, Douglas W. Elmendorf, posted a blog entry on Monday that said he would need more detail than the White House has provided to conduct an analysis -- and even with such details, ''analyzing the proposal would be a time-consuming process that could not be completed this week.''

In many respects, Mr. Obama's measure looks much like the version the Senate passed on Dec. 24 -- and indeed, senior White House officials acknowledged Monday that they had used the Senate bill as a template. Like the Senate version, Mr. Obama's bill does not include a so-called public option, a government-backed insurance plan to compete with the private sector.

And the bill offers the Senate's less-restrictive language on abortion; it does not include the ''Stupak amendment,'' which would bar insurers from offering abortion coverage to anyone buying a policy with a federal subsidy. The absence of that provision could complicate matters for Mr. Obama in the House, where abortion opponents are adamant that the language be included.

In one sense, the release of the bill is an extraordinary reversal for a president who has long said he would leave legislating to the legislators. But with the House and Senate unable to reconcile their differences, Mr. Obama, who had promised to post a Democratic bill on the Internet 72 hours before Thursday's meeting, was left with little choice but to issue a plan of his own.

Even Democrats seemed uncertain on Monday where the process would lead. But some said that if Mr. Obama has done nothing else, he has revived the public debate over health care and created a political climate that allows Democrats to talk about it again -- something that seemed impossible just a few short weeks ago, after a Republican Senate victory in Massachusetts threw the bill off track.

''It was like calling a timeout in basketball,'' said John D. Podesta, who ran Mr. Obama's transition team and was chief of staff to President Bill Clinton. ''Everybody came back to the sides; now they can go back on the court.''

CHART: The President's Health Care Proposal: President Obama's proposal for overhauling health care largely resembles the legislation passed by the Senate but incorporates some elements of the bill approved by the House. A look at the major provisions: (A19)